| Martinsville Henry County Coalition For Health And Wellness | |
|
324 T B Stanley Hwy Ste B And C Bassett VA 24055-6108 | |
| (276) 638-0787 | |
| (276) 629-2695 |
| Full Name | Martinsville Henry County Coalition For Health And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 324 T B Stanley Hwy, Bassett, Virginia |
| Authorized Official Name and Position | Gina Finocchiaro (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2764035096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martinsville Henry County Coalition For Health And Wellness 29 Jones St Martinsville VA 24112-2716 Ph: (276) 638-0787 | Martinsville Henry County Coalition For Health And Wellness 324 T B Stanley Hwy Ste B And C Bassett VA 24055-6108 Ph: (276) 638-0787 |
| NPI Number | 1063608081 |
|---|---|
| Provider Enumeration Date | 09/24/2007 |
| Last Update Date | 10/16/2024 |
| Medicare PECOS PAC ID | 4385717552 |
|---|---|
| Medicare Enrollment ID | O20080721000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063608081 | NPI | - | NPPES |
| 1063608081 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Edna Ekuban-gordon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033143466 PECOS PAC ID: 2062405970 Enrollment ID: I20101122000266 |
| Provider Name | Amanda Lynn Keith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689034514 PECOS PAC ID: 1557668803 Enrollment ID: I20160411000657 |
| Provider Name | Joanna L Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477094480 PECOS PAC ID: 7911274097 Enrollment ID: I20180925002983 |
| Provider Name | Felecia Harris Mcbride |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275956583 PECOS PAC ID: 9133555220 Enrollment ID: I20200210000559 |
| Provider Name | Ashley H Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962032854 PECOS PAC ID: 5597175810 Enrollment ID: I20201027002991 |
| Provider Name | Amanda Gail Hatcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679183115 PECOS PAC ID: 8820401730 Enrollment ID: I20210114001998 |
| Provider Name | Kimberly Sue Gravely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952998858 PECOS PAC ID: 7416364971 Enrollment ID: I20210329002151 |
| Provider Name | Kate Erin Ryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558865022 PECOS PAC ID: 1254689474 Enrollment ID: I20220131000845 |
| Provider Name | Jennifer Walker Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134798564 PECOS PAC ID: 0345637625 Enrollment ID: I20220505001478 |
| Provider Name | Lacinda Ann Foley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508511924 PECOS PAC ID: 8022497411 Enrollment ID: I20220615000383 |
| Provider Name | Landon R Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194376608 PECOS PAC ID: 1052745007 Enrollment ID: I20220917000209 |
| Provider Name | Rebbeca Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114931003 PECOS PAC ID: 9931241189 Enrollment ID: I20230207002845 |
| Provider Name | Luzmila Zona Via |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740979251 PECOS PAC ID: 5193179034 Enrollment ID: I20230927001112 |
| Provider Name | Sarah Lynn Padgett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225881808 PECOS PAC ID: 9830531896 Enrollment ID: I20240522004332 |
| Provider Name | Bethany Gravely |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245732262 PECOS PAC ID: 1951656610 Enrollment ID: I20240829002609 |
| Provider Name | Tykiesha Mcdaniel Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396576724 PECOS PAC ID: 3577084938 Enrollment ID: I20250303000927 |
Fatade Health And Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 255 Riverside Dr, Bassett, VA 24055 Phone: 276-627-8070 Fax: 276-627-8069 |